Reducing bacterial resistance with IMPACT Fifth Edition

Modified Duke Criteria for Infective Endocarditis

Formula

“Definite” IE:

One or more pathologic criteria, or
Clinical criteria

2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria

“Possible” IE:

1 major criterion and 1 minor criterion, or
3 minor criterion

“Rejected”:

Firm alternative diagnosis explaining evidence of IE, or
Resolution of IE symptoms with antibiotics for <= 4 days, or
No pathological evidence of IE at surgery or autopsy, with antibiotic therapy <= 4 days, or
Does not meet criteria of “possible” IE, as above.

Pathologic Criteria
Microorganisms demonstrated by culture or histologic examination of a vegetation,a vegetation that has embolized, or an intracardiac abscess specimen; or	Yes No
Pathologic Lesions: Vegetation or intracardiac abscess confirmed by histologic examination showing active endocarditis	Yes No
Major Clinical Criteria
Blood culture positive for IE Typical microorganism consistent with IE from 2 separate blood cultures (Viridans streptococci, Streptococcus bovis, HACEK group, Staphylococcus aureus; or Community-acquired enterococci, in the absence of a primary focus); OR Microorganisms consistent with IE from persistently positive blood cultures, defined as: At least 2 positive cultures of blood samples drawn >12 hour apart; or All of 3 or a majority of >= 4 separate cultures of blood (with first and last sample drawn at least 1 hour apart) Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800	Yes No
Evidence of endocardial involvement Echocardiogram positive for IE (TEE¹ recommended in patients with prosthetic valves, rated at least “possible IE”by clinical criteria, or complicated IE [paravalvular abscess]; TTE as first test in other patients.) Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, OR Abscess, OR New partial dehiscence of prosthetic valve New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)	Yes No
¹ TEE, transoesophageal echocardiography; TTE, transthoracic echocardiography.
Minor Clinical Criteria²
² Echocardiographic minor criteria eliminated
Predisposing heart condition or injection drug use	Yes No
Fever, temperature > 38°C (or 100.4°F)	Yes No
Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway’s lesions	Yes No
Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth’s spots, and rheumatoid factor	Yes No
Microbiological evidence: positive blood culture but does not meet a major criterion as noted above³ or serological evidence of active infection with organism consistent with IE	Yes No
³ Excludes single positive cultures for coagulase-negative staphylococci and organisms that do not cause endocarditis.
Rejecting criteria
Firm alternative diagnosis explaining evidence of IE.	Yes No
Resolution of IE symptoms with antibiotics for ≤ 4 days.	Yes No
No pathological evidence of IE at surgery or autopsy, with antibiotic therapy ≤ 4 days	Yes No
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Result:	infective endocarditis according to Modified Duke Criteria.

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Modified Duke Criteria for Infective Endocarditis